A Healthcare Carol

- Peter J. Pitts, a former FDA Associate Commissioner, is Partner/Director of Global Health at Porter Novelli and President of the Center for Medicine in the Public Interest. The opinions expressed are his own. -

Late one recent wintry night in the midst of the Senateâ€™s deliberations over healthcare reform, having worked hard on trying to reconcile the many swirling eddies of the current debate, I retired to bed for a few hours of fitful respite. That is until I was awoken from my solemn slumbers by a billowy translucent apparition who identified himself as the Ghost of Healthcares Yet-to-Come.

â€śAway ye spirit,â€ť I intoned, â€śfor I need my sleep and indeed see you for what you really are â€“ a detail rep for Lunesta.â€ť â€śNay,â€ť replied the apparition. â€śI am here to reveal to you alternate realities for healthcares yet-to-come.â€ť And, with a wave of his spectral hand, appeared a magical black bag. â€śLook within,â€ť he intoned.Â â€śAnd see how the future of American healthcare can unfold.â€ť â€śDid you bring a pizza by any chance,â€ť I queried? â€śSorry, canâ€™t do that any more,â€ť the ghost replied.Â â€śLet our journey begin.â€ť

And from inside his satchel he ceremoniously withdrew a heavy, leather-bound tome with a caduceus embossed on the cover. â€śWhat alchemistâ€™s manual is this?â€ť asked I. â€śIt is,â€ť whispered the spirit, â€śfrom the cabinet of doctors Pelosi and Reid.Â It is the final version of healthcare reform legislation.â€ť

â€śOh splendid visitor,â€ť I pleaded. â€śMay I gaze upon these pages and take notes for my blog? â€śNO!â€ť the ghost sternly admonished. â€śYou may look at the book, but may never read what is inside â€“ just like members of Congress before the final vote.â€ť

â€śNot fair,â€ť said I. â€śAlas,â€ť the specter replied. â€śSuch is the future when healthcare legislation is focused primarily on politics rather than on advancing the public health.â€ť

â€śBut it need not be that way,â€ť my navigator continued. â€śLet us move on an alternate future.â€ť And with that he once again reached down into his black bag, revealing not a book but a Kindle. â€śPower it up,â€ť he directed. â€śAnd see another future for American healthcare.â€ť

And it was wondrous. A future of enhanced access, innovation and accelerated approvals. A future where, with appropriate FDA guidance, pharmaceutical companies actively engage in social media.Â A future where insurance companies reward its customers for medication compliance, weight loss, smoking cessation, and disease prevention.Â A future with a national standard for electronic medical records and e-prescribing.Â A future where the insurance industry offers high-quality health policies across state lines to the many millions of previously uncovered Americans at significantly lower costs.Â A future where reimbursement decisions are based on patient-centric concerns rather than 20th century cost-centered models.Â A future where physicians are compensated fairly by Medicare and Medicaid.Â A future where, through enhanced transatlantic regulatory harmonization, there is no â€śapproval gapâ€ť for drugs, devices, or diagnostics. A future where the only doughnut hole question we consider is cream-filled or regular. A future where drug importation is a side show panel not in the U.S. Senate, but at Ripleyâ€™s Believe-it-or-Not.

â€śCan we peer into the future of the FDA,â€ť I wondered.

â€śYouâ€™re such a wonk,â€ť said my ethereal companion. â€śIf you insist.â€ť

And insist I did.Â As I browsed further into the magic Kindle I saw an FDA thatâ€™s both regulator in protecting the public health and colleague in helping to advance it via the Reagan Udall Foundation. I saw an FDA with a cutting-edge information management system. I saw an FDA that embraces predictability over ambiguity. I saw an FDA that understands the unintended consequences of early risk communications.

â€śIs such a future possible,â€ť I asked.

â€śIndeed it is,â€ť the eidolon answered.Â â€śIt is possible if we believe.â€ť

â€śIf we believe in what,â€ť I asked.Â â€śIn Santa Claus?â€ť

â€śNo, intoned the wraith, â€śin the Non-Interference Clause. If we believe in free market competition and personal responsibility; in putting and keeping the patient in the center of every conversation; at long-term rather than short-term savings; in hard facts rather than political platitudes; in allies rather than enemies. If we believe that, in order to save lives, reduce costs, enhance quality, and deliver on the promise of robust health to all groups of Americans, all of the players in the health care debate – including government – must work together as a team, as a unit, as a public health defense force armed and ready to advance the public health.â€ť

â€śHow can we ensure this pathway,â€ť I beseeched. “Let me tell you,â€ť said the phantasm, â€śwhat my friend Ebenezer Scrooge once said to a colleague of mine. He said that men’s courses will foreshadow certain ends, to which, if persevered in, they must lead.â€ť

“But,â€ť I asked, â€śif the courses be departed from, the ends will change. Say it is thus with what you show me.” But, before he could answer, I saw an alteration in the Phantom’s hood and dress. It shrunk, collapsed, and dwindled down into a bedpost.